Organization
NORTHLAKE PEDIATRIC CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BORJA MD (OWNER)
(704) 871-2323
Entity
Organization
Contact information
Practice address
2117 SIMONTON RD, SUITE 402, STATESVILLE, NC 28625-8206
(704) 871-2323
(803) 619-2149
Mailing address
2117 SIMONTON RD, SUITE 402, STATESVILLE, NC 28625-8206
(704) 871-2323
(803) 619-2149
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1002P
BCBS OF NC
NC
01
—
34D1014813
CLIA ID
—
05
—
5918872
—
NC
Enumeration date
08/20/2006
Last updated
05/30/2013
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